Healthcare Provider Details

I. General information

NPI: 1174317143
Provider Name (Legal Business Name): INDY TEEN TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 PARKDALE PL STE N
INDIANAPOLIS IN
46254-4697
US

IV. Provider business mailing address

1451 ROUTE 88 STE 5
BRICK NJ
08724-2371
US

V. Phone/Fax

Practice location:
  • Phone: 845-372-6480
  • Fax:
Mailing address:
  • Phone: 845-372-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ZEIGER
Title or Position: OWNER
Credential:
Phone: 845-372-6480